The Pharmaceutical Care of Patients with Long Term Conditions Deirdre Watt Team Leader, Community Pharmacy Scottish Government

Objectives Set out community pharmacy role Define concept of pharmaceutical care Describe the Chronic Medication Service Consider clinical benefits Outline timetable for delivery

Community Pharmacy Role Developing the role of the pharmacist Address health inequalities Make better use of the workforce Maximise clinical outcomes Public Health Service Services and information Smoking cessation clinics, sexual health advice Minor Ailment Service Free for those who do not pay for prescriptions Over 600,000 registered – treat or refer

The Patient Journey Patient has GP appointment Prescription taken to pharmacy At least 5.2% of items not dispensed Patient takes medication 30-50% non-adherence 2.7% - 6.5% hospital admission due to Adverse Drug Reaction (ADR) Outpatients 5% of medicines not added to the GP record

Minor Ailment Service Over 600,000 patients registered 90,000 consultations per month Extremely positive patient feedback

MAS Trends Registration Over % Under % Income related - 19% Maternity / HBE - 7% (education) - 1% Prescribing Paracetamol (18%) Ibuprofen (7%) Chloramphenicol (5%) Malathion (4%) Clotrimazole (4%)

Unscheduled Care PGD Provision of medicines under a national Patient Group Direction (PGD) when a GP is unavailable Pharmacist can give up to one prescribing cycle of a patient’s medicines PGD covers all medicines in the British National Formulary (BNF) – with exceptions detailed (e.g. controlled drug, hospital only treatments)

Unscheduled Care PGD usage

Chronic Medication Service (CMS) Description Personalised pharmaceutical care for patients with long term medical conditions. Purpose Maximise clinical outcomes for patients Minimise predictable undesirable effects Increase patient understanding of their medicine – increase compliance, reduce waste

Three Stages 1. Patient registration 2. Pharmaceutical care planning 3. Shared care

CMS Outline Stage 1 Patient registers with a community pharmacy of their choice Voluntary – register with one pharmacy only Underpinned by patient consent Stage 2 Pharmacist assesses patient Pharmacist develops a pharmaceutical care plan Stage 3 GP issues a serial prescription: 24 or 48 weeks Pharmacist dispenses prescription at agreed intervals Feedback to GP practice – end of care treatment summary Review or repeat

Improved Concordance Stage 2: Pharmaceutical care planning Patient and pharmacist Discuss and assess the patient’s condition/s, medicine/s and general health Identify any issues / problems Establish desired outcomes Agree any actions to address them Pharmacist Documents the issues, desired outcomes and actions in a pharmaceutical care plan Monitors and reviews the care plan

Timetable to CMS Early adopter testing in Fife Develop toolkit for implementation 8 week consolidated end to end testing Registration Serial prescription End of care treatment summary Roll out from October Full CMS for patients with exemptions Complete roll out to all – April 2011

Summary – CMS Benefits Improved clinical outcomes Improved concordance Reduced wastage Easier patient journey Promotion of self care Better utilisation of the workforce Encourage team working

New Community Pharmacy Contract Benefits Improved access Medicines Pharmaceutical advice Managing demand GP practice NHS 24 A&E Addressing health inequalities Shifting the balance of care